A -year-old man is brought to the emergency department due to severe lower abdominal pain and an inability to pass urine for the past hours. He has a history of benign prostatic hyperplasia for which he takes tamsulosin inconsistently. His temperature is , blood pressure is , pulse is , and respiratory rate is . Physical examination reveals a distressed patient in apparent pain. The abdomen is non-distended, but there is a palpable, tender, rounded mass extending from the pubic symphysis to the umbilicus. Digital rectal examination reveals a diffusely enlarged, smooth, and firm prostate without nodules. Which of the following is the most appropriate next step in management?
- Placement of a urethral Foley catheterAnswer
- BNon-contrast CT scan of the abdomen and pelvis
- CEmpiric administration of intravenous ciprofloxacin
- DAdministration of intravenous fluids and observation
- EMeasurement of serum prostate-specific antigen levels
Answer
Placement of a urethral Foley catheter is the most appropriate next step.
The correct action is the placement of a urethral Foley catheter. This patient's presentation of severe suprapubic pain, inability to void, and a palpable suprapubic mass is the classic triad of acute urinary retention (AUR). Given his history of benign prostatic hyperplasia (BPH) and medication non-adherence, mechanical outflow obstruction is the definitive cause. The immediate, primary goal in AUR is to decompress the bladder to relieve the patient's severe pain and to prevent permanent bladder dysfunction or post-renal acute kidney injury. Urethral catheterization is the safest, most rapid, and most effective first-line method to achieve this.
Step-by-Step Solution
Key Concept
The immediate management of acute urinary retention is prompt bladder decompression, most commonly achieved with a urethral Foley catheter.